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Human capacity-building plan for scaling up HIV/AIDS treatment

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Objective: develop a national approach to training and human resources

The emergency establishment of a skilled health workforce is a prerequisite for achieving 3 by 5 and challenges health systems as a whole.

An absolute shortage of personnel with specific HIV/AIDS skills represents only one critical challenge to meeting the human resource needs for 3 by 5. Other challenges include the appropriate distribution of tasks, the migration of health care workers, the retention of trained personnel in their positions and/or the country where they are trained, working conditions and occupational safety, stigma attached to working on HIV/AIDS and, most notably, the impact of HIV/AIDS on staff itself. Finally, although a well trained workforce is an essential prerequisite to high-quality health care, quality is also determined by the organization of the health care system in which the workforce is operating.

The rapid training of many individuals is an important element of the response, and such training efforts must be based on a thorough understanding of appropriate delivery models and the related human resource needs. However, training alone is insufficient to ensure the availability and retention of an adequate workforce. In a sustainable approach to developing human resources for achieving 3 by 5, emergency pre- and in-service training must be embedded in a flexible national process of developing human resources – ensuring the match between the workforce needs and the supply for 3 by 5 while making sure that other parts of the health sector are not harmed.

Strategic approach

The emergency expansion of a workforce contributing to 3 by 5 needs to be embedded in the development and implementation of national plans for training and capacity-building for scaling up antiretroviral therapy.

Such a process must be driven and owned by each country. The strategic approach hence builds on the support of in-country collaboration on capacity-building bringing together governments and dedicated stakeholders and partners under the umbrella of the appropriate mechanisms for HIV/AIDS coordination. WHO will support countries in managing national training and capacity-building for HIV/AIDS in the short term and in implementing sustainable approaches to human resource development in the medium term.

In-country work will be complemented by backing activities at the regional and global level that seek to elicit and make accessible guidance for planning human resources based on a review of international experience. This includes developing standardized instruments for assessing, planning and evaluating human resources and for developing policy options and case studies. Finally, WHO will work with organizational partners and governments at the global level to advocate for removing obstacles to the national development of human resources that are rooted in international contexts.

Expected activities and results

National training and human resource planning. WHO will help to establish dedicated in-country capacity-building task teams and support them in applying human resource planning methods to review existing and/or create plans that respond to achieving 3 by 5. In the short term, this process focuses on developing national plans for training and capacitybuilding founded on rapid assessment of the human resource situation, including reviewing clinical and preventive tasks at various programme levels. The plan will focus on translating nationally adopted models of service delivery into training needs, unleashing and strengthening existing training capacity, establishing partnerships with communities for sharing tasks and responsibilities in antiretroviral therapy services, supporting strategies for reducing stigma, devising short-term measures for increasing the workforce where needed (such as re-engaging retired staff, inducing inactive trained personnel back into service and external recruitment for key posts such as training tutors), improving working conditions and occupational safety, devising incentives to aid recruitment and increase productivity and establishing incentive systems for trainers, such as employment progression. In the medium term, plans for human resource development will be developed that anticipate and manage system-wide workforce demand and supply. Supportive action will focus on: changing legislation and regulations to ensure appropriate investment in human resources and to maximize human resource use; developing new cadres of health care workers; identifying new mixes of human resource skills; developing policies to address the problems of retaining human resources and substituting health workers; and increasing the capacity for monitoring and evaluating human resource development. Involvement of partners. At the national level, partners are encouraged to participate in WHOsupported capacity-building task teams, including governments, nongovernmental organizations, community-based organizations and representatives of international organizations. Service for countries. Task teams will help countries in developing comprehensive plans for training and human resource development that can manage the workforce qualification and/or expansion in a sustainable manner.

Networks of capacity-building experts. WHO headquarters and the regional offices will support the development of networks and rosters of regionally versed experts and institutions that can support countries in designing nationally tailored training programmes that address antiretroviral therapy in the context of HIV prevention and comprehensive care and support based on a sound analysis of the situation in each country. WHO will familiarize these experts with current approaches and guidelines and call upon them to support the development of national human resource plans through training on methods for human resource planning and direct technical assistance. Involvement of partners. WHO will work with partner institutions and networks to determine suitable individuals and upgrade their skills. Service for countries. WHO will work with countries to determine the specific expertise needed and to identify appropriate experts.

Global guidance to human resource planning. WHO will carefully review the experience of countries in developing human resources for scaling up antiretroviral therapy in order to develop guiding material based on the comparative analysis between countries identifying similarities, differences and good practices. Involvement of partners. Partners will be invited to share their experience and participate in developing guidance material. Service for countries. Countries will have immediate access to guiding material through WHO offices and the international Capacity-Building Help Deskvi (see the objective on providing technical support for training).

Global advocacy and monitoring. At the global level, WHO will maintain an inventory of national plans for human resource development and monitor progress in and barriers to expanding the workforce for achieving 3 by 5. In addition, WHO will work with global partners and governments to resolve barriers to the national development of human resources associated with international phenomena, such as the migration of health care workers from resource-poor to resource-rich countries. Involvement of partners. Partners will be invited to contribute to resolving international barriers through participation in fora and consultations. Service for countries. Countries will be regularly informed of the progress made in global advocacy efforts.